Shateka McCartha
Goodyear,AZ
Summary
Dedicated Customer Care Representative with over 10 years of comprehensive experience in data entry, claims processing, insurance verification, conflict resolution, premium billing, and call management across diverse settings, including call centers and remote environments. Expertise in generating detailed data reports and enhancing customer satisfaction through effective communication and problem-solving skills. Proficient in leveraging Microsoft Office and Google Suite applications to streamline operations and improve efficiency. Committed to delivering exceptional service and fostering positive relationships with clients and colleagues.
Overview
16
16
years of professional experience
Work History
Enrollment Process Associate - Remote
CVS Health, Inc.
09.2024 - 09.2025
- Perform data entry, validation, and record-keeping in compliance with HIPAA and company policies.
- Successfully handled on average 50-75 calls daily and over 100 calls on high-volume days. Increased number of calls handled in a call center environment.
- Utilize skills in Microsoft PowerPoint, Excel, Word and Outlook with good data entry typing speed of 45-50 WPM.
- Process and review faxed prescriptions accurately and within turnaround time.
- Focused largely on Priority status and information accuracy.
- Assist internal teams with administrative tasks such as document preparation, system updates, and audit support.
- Communicate with internal departments via email and Teams to resolve issues.
- Maintain a high level of accuracy and attention to detail in all assigned tasks.
- Follow standard operating procedures and escalate issues to supervisors when necessary.
- Inbound call volumes from patients, insurance representatives and attorneys.
- Verifying patient's eligibility, updating patient demographics and insurance information.
- Research patient out-of-pocket responsibility and working accounts under billing guidelines.
Patient Accounts Associate - Remote
Brault, Inc.
04.2024 - 08.2024
- Handle high inbound call volumes from patients, insurance representatives, and attorneys.
- Conducted thorough verification of patient eligibility against insurance policies. Regularly updated patient demographic and insurance details to enhance record integrity.
- Examine patient financial obligations and oversee accounts in accordance with billing guidelines
- Harness capabilities in Microsoft PowerPoint, Excel, Word, and Outlook while maintaining effective data entry typing speed of 35-40 WPM.
- Effectively managed between 50 and 75 calls each day, surpassing 100 during high-traffic periods. Boosted call handling capabilities in a dynamic call center environment.
Eligibility Coordinator - Remote
Molina Healthcare, Inc
08.2021 - 03.2024
- Directed management of eligibility exceptions and compiled daily reports detailing enrollment inconsistencies for Molina Healthcare Insurance.
- Guided consumers through understanding insurance coverage options, deductibles, co-insurance, and premiums.
- Handled daily enrollee invoices and conducted premium reconciliation, decreasing billing errors by 20%.
- Directed management of Medicare Part B and D alongside commercial plans PBM activities and prior authorizations.
- Addressed invoice discrepancies before monthly reporting, guaranteeing accurate financial records
- Coordinated efforts with enrollment team to rectify eligibility discrepancies, increasing premium billing precision
- Meticulously handled third-party billing claims and reliably supported prior authorization completion.
- Produced reports and billing data through premium billing module, optimizing print and fulfillment workflows.
- Performed monthly eligibility reconciliations, upholding data integrity for 5,000+ members.
- Conducted outbound calls while confirming third-party insurances, managed claims in claims queue and revised enrollment records.
- Facilitated exceptional customer service for assigned insured and claimants during claims process, providing prompt assistance to customers.
- Led data analysis efforts in ID card processing and generation, rectifying member addresses according to standard operating procedure.
- Managed Premium Billing and state enrollment transactions with precision.
- Facilitated addition of new members in response to state requests.
- Facilitated monthly reporting duties essential for member access to care.
- Oversaw I Serve queue and designated tickets for enrollment team.
- Directed newborn enrollment reporting activities.
- Managed PCP assignments to ensure timely completion.
- Implemented enrollment modifications in accordance with 834 enrollment files.
- Handled 100-150 calls daily with consistent typing speed of 45-50 WPM in fast-paced call center
- Employ skills in Microsoft PowerPoint, Excel, Word, and Outlook alongside data entry typing speed of 35-40 WPM.
Provider Services Representative - Hybrid
Optum Care, Inc.
11.2017 - 07.2021
- Oversaw inbound calls from providers and billing departments inquiring about claim statuses.
- Facilitates incoming calls from members and providers, delivering professional phone assistance through criteria-based prior authorization process.
- Ensures comprehensive, timely, and accurate documentation of all approvals and denials
- Utilize knowledge of Medicare (Part A, Part B, and Part D), Medicaid, and third-party payer requirements to verify patient coverage and policy limitations using online eligibility systems.
- Assesses and grants approval for prior authorization pharmacy requests from prescribers received via telephone and/or facsimile according to client clinical criteria.
- Articulates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician office staff, medical management personnel, and pharmacists.
- Validate primary insurance eligibility via phone with agents or online for Medicaid, Part D, Medicare Part B recipients, determining payment responsibilities to providers and confirming coverage specifics.
- Executed Telehealth video visits addressing issues with patients, providers, or staff members related to Zoom, Secure video, VSee, and Vivify across multiple device types including smartphones, desktops, and tablets.
- Executed prior authorization requests, managed appeals and escalations.
- Leverage expertise in Microsoft PowerPoint, Excel, Word, and Outlook with proficient data entry typing speed of 35-40 WPM.
- Managed daily call volume averaging 50 to 75, exceeding 100 during peak periods. Enhanced call handling efficiency in a high-volume call center environment.
Client Services Member Representative
Fun Brands Carousel
03.2017 - 11.2017
- Coordinated high volumes of inbound sales calls for PumpItUp and BounceU clients centered on birthday and event scheduling.
- Specified aspects of party package pricing, food ordering logistics, and scheduling strategies.
- Managed deposit payment transactions
- Assisted new entrepreneurs by addressing ZenDesk tickets related to location setup, payment processing, event equipment, and inventory oversight.
- Achieved an impressive average of 70 to 90 calls daily, exceeding 110 during high-demand times. Improved call handling efficiency within a dynamic call center setting.
Client Services Representative
NYS Dept. of Health
09.2016 - 02.2017
- Guided Commerce Account holders through troubleshooting processes for account pin number and user ID retrieval, password resets, and new account registrations in call center context.
- Mitigated user difficulties associated with online assessments
- Contributed to Multi-Factor Authentication (MFA) procedure via Department of Motor Vehicles identity verification website.
- Instructed users with comprehensive steps for securing verification codes and applying new assessment methods.
- Maintained strict adherence to HIPAA guidelines
Member Services Representative
Maximus Inc.
11.2014 - 09.2016
- Guided clients through application procedures for health insurance with Affordable Care Act across New York State and Access Health CT in Connecticut
- Inform callers regarding Affordable Care Act, NYHBE call center eligibility screening, enrollment guidelines, exemptions, and initial eligibility determinations.
- Obtain, assess, authenticate, and oversee customer contact data while addressing inquiries and complaints.
- Managed resolution of account issues to improve client relations. Processed Medicaid determinations swiftly and correctly. Facilitated communication by coordinating with language line interpreters. Collaborated with application assisters and navigators for comprehensive client support.
- Maintained detailed documentation of all calls in Siebel CRM database. Filed desk tickets in JIRA to facilitate prompt issue resolution.
- Authenticate member eligibility for Medicaid and evaluate Advanced Premium Tax Credit qualifications.
- Facilitated 50-70 calls per day and demonstrated proficiency in Microsoft Excel, Word, PowerPoint.
Patient Services Representative
Upper Hudson Planned Parenthood
04.2011 - 11.2014
- Welcomed patients and visitors, enhancing clinic experience. Executed patient check-in and checkout procedures, ensuring co-pays and prior authorizations were collected. Facilitated accurate insurance processing through diligent data collection.
- Managed data input functions, organized patient scheduling, directed inbound and outbound calling operations, executed EMR Electronic Medical Records scanning/filing activities, proficient in Microsoft Outlook, Image Scan, Excel, NextGen, and eMedny applications.
- Directed front desk activities for Albany and Troy, NY sites.
- Handled heavy call volumes efficiently, prioritizing urgent patient needs. Facilitated timely prior authorization processes for referrals. Verified patient insurance information to support seamless service delivery.
Patient Services Representative
New York Cardiovascular
04.2009 - 03.2011
- Streamlined appointment scheduling processes to enhance service delivery. Created a positive first impression by greeting patients and visitors professionally. Organized patient medical records meticulously for quick reference. Ensured accurate insurance verification to confirm patient coverage. Executed check-in and check-out procedures smoothly.
- Administered copay and out-of-pocket cost collection upon patient arrival while organizing hospital admission and laboratory services.
- Cleaned and organized examination rooms to uphold high standards of hygiene. Managed supply ordering and restocking to guarantee availability for operations.
- Executed payment method processing for service transactions.
- Copying, faxing, managing administrative responsibilities and operating various job-related digital platforms.
Education
GED -
Auburn High School
Auburn, NY03.2006
Skills
- Help desk software (Zendesk)
- Epic design
- Salesforce software
- IT service management
- Client management software
- Digital workspace technology
- New York state Medicaid
- Health plan management (QNXT)
- Telephony tracking
- Email communication support
- Online messaging support
- Medicaid application management
- Medicare sign-up
- Digital asset handling
- Admission prerequisites
- Data entry speed
Timeline
Enrollment Process Associate - Remote
CVS Health, Inc.
09.2024 - 09.2025
Patient Accounts Associate - Remote
Brault, Inc.
04.2024 - 08.2024
Eligibility Coordinator - Remote
Molina Healthcare, Inc
08.2021 - 03.2024
Provider Services Representative - Hybrid
Optum Care, Inc.
11.2017 - 07.2021
Client Services Member Representative
Fun Brands Carousel
03.2017 - 11.2017
Client Services Representative
NYS Dept. of Health
09.2016 - 02.2017
Member Services Representative
Maximus Inc.
11.2014 - 09.2016
Patient Services Representative
Upper Hudson Planned Parenthood
04.2011 - 11.2014
Patient Services Representative
New York Cardiovascular
04.2009 - 03.2011
GED -
Auburn High School